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Meta-Analysis
. 2020 Jan 31;40(1):BSR20191312.
doi: 10.1042/BSR20191312.

Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis

Yuan-Zhi Chen  1 , Li-Chang Sun  1 , Yao-Hong Wen  1 , Zhong-Wei Li  1 , Shu-Jin Fan  1 , Hong-Kun Tan  1 , Min Qiu  1 , Zhi-Yong Pan  1 , Qin Li  2 , Yan-Zhen Zhao  3 , Zhen-Xing Li  1 , Xu-Guang Guo  1   3   4   5
Affiliations
Meta-Analysis

Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis

Yuan-Zhi Chen et al. Biosci Rep. .

Abstract

Background: Tuberculous meningitis (TBM) is one of the most serious types of extrapulmonary tuberculosis. However, low sensitivity of culture of cerebrospinal fluid (CSF) increases the difficulty in clinical diagnosis, leading to diagnostic delay, and misdiagnosis. Xpert MTB/RIF assay is a rapid and simple method to detect tuberculosis. However, the efficacy of this technique in diagnosing TBM remains unclear. Therefore, a meta-analysis was conducted to evaluate the diagnostic efficacy of Xpert MTB/RIF for TBM, which may enhance the development of early diagnosis of TBM.

Methods: Relevant studies in the PubMed, Embase, and Web of Science databases were retrieved using the keywords 'Xpert MTB/RIF', 'tuberculous meningitis (TBM)'. The pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, summary receiver operator characteristic curve, and area under the curve (AUC) of Xpert MTB/RIF were determined and analyzed.

Results: A total of 162 studies were enrolled and only 14 met the criteria for meta-analysis. The overall pooled sensitivity of Xpert MTB/RIF was 63% [95% confidence interval (CI), 59-66%], while the overall pooled specificity was 98.1% (95% CI, 97.5-98.5%). The pooled values of positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 20.91% (12.71-52.82%), 0.40% (0.32-0.50%), and 71.49% (32.64-156.56%), respectively. The AUC was 0.76.

Conclusions: Xpert MTB/RIF exhibited high specificity in diagnosing TBM in CSF samples, but its sensitivity was relatively low. It is necessary to combine other high-sensitive detection methods for the early diagnosis of TBM. Moreover, the centrifugation of CSF samples was found to be beneficial in improving the sensitivity.

Keywords: Diagnosis; Xpert MTB/RIF; meta analysis; tuberculous meningitis.

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Conflict of interest statement

The authors declare that there are no competing interests associated with the manuscript.

Figures

Figure 1
Figure 1. Flow diagram of study identification and inclusion
From: Moher D., Liberati A., Tetzlaff J., Altman D.G. and The PRISMA Group (2009) Preferred Reporting /tems for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med.6(7), e1000097, doi:10.1371/journal.pmed1000097
Figure 2
Figure 2. Quality evaluation of the included studies
Figure 3
Figure 3. Risk of bias and applicability concerns graph: review authors’ judgments about each domain presented as percentages across the included studies
Figure 4
Figure 4. Deeks’ funnel plot asymmetry test to assess publication bias in estimates of diagnostic odds ratio for Xpert MTB/RIF detection of TBM
Figure 5
Figure 5. SROC curves of TBM detected by Xpert MTB/RIF
Figure 6
Figure 6. Forest plots for the pooled sensitivity of Xpert MTB/RIF
Figure 7
Figure 7. Forest plots for the pooled specificity of Xpert MTB/RIF
Figure 8
Figure 8. Forest plots for the pooled positive likelihood ratio of Xpert MTB/RIF
Figure 9
Figure 9. Forest plots for the pooled negative likelihood ratio of Xpert MTB/RIF
Figure 10
Figure 10. Forest plots for the pooled diagnostic odds ratio of Xpert MTB/RIF
See this image and copyright information in PMC

References

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